Clinical Quality Analyst Coding

Overview

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.

Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.

Monday through Friday from 8:30 am to 5:00 pm

2716 North Tenaya Way, Las Vegas, NV 89128

Clinical Quality Analyst Coding – supports IPA Providers with ongoing ICD 10 CM Coding Education relating to Medicare Advantage – Risk Adjustment CMS Documentation & Coding Guidelines by providing tools to allow for greater meaningful information exchange.

• Provide coding and documentation improvement education and training to IPA Providers consistent with network goals, objectives and best practices.
• Collaborate with organizational leaders to identify emerging needs and generate solutions.
• Serve as a Coding and Documentation resource to IPA Providers by performing concurrent reviews and targeted chart or HEDIS retrievals in provider offices.
• Communicate coding audit findings, industry updates and common medical documentation issues to providers to ensure CMS and Optum compliance guidelines.
• Perform coding reviews through Internal System.
• Participate in the development and onboarding of various programs for IPA providers.
• Translate concepts into practice.
• Develop and implement effective analysis, research and evaluation of quality measures required for member demographic (Care of Older Adults (COA), Diagnostic and lab testing).
• Develop and maintain working relationships with our clinic partners, including providers and their support staff in person.
• Work with multiple internal and external partners at various levels of the organization.
• Adhere to project goals / milestones based on identified business needs / timelines, and obtain appropriate approvals.
• Adhere to established guidelines for formatting and templates.
• Functions as part of a collaborative, high‑functioning coding education team.
• Manage multiple tasks and projects, forging solid interpersonal relationships within the department, with other departments and with external audiences.
• Work with minimal guidance; seeks guidance on only the most complex tasks.
• Quickly troubleshoot and identify the cause of questionable results within reports, provider documentation or charges submitted.
• Require an in‑person presence in various provider offices routinely.
• Move, lift and / or push 25+ pounds.
• Maintain flexibility and adjust working hours according to provider needs.
• Adhere to department standards for productivity and performance.
• Adhere to HIPAA Confidentiality Standards.
• Attend monthly IPA Team meeting in person.
• Work is self‑directed and not prescribed; handles less structured, more complex issues; serves as a resource to others.

• Paid Time Off accrued with your first pay period plus 8 Paid Holidays.
• Medical plan options with Health Spending Account or Health Saving account participation.
• Dental, Vision, Life & AD&D Insurance and Short‑term & Long‑term Disability coverage.
• 401(k) Savings Plan and Employee Stock Purchase Plan.
• Education Reimbursement.
• Employee Discounts and Assistance Program.
• Employee Referral Bonus Program.
• Voluntary benefits (pet insurance, legal insurance, LTC Insurance, etc.).

• High School Diploma/GED (or higher).
• Coding Certification from AAPC or AHIMA (e.g., CPC, CPC‑H, CPC‑P, RHIT, RHIA, CCS, CCS‑P, CRC) or RN/LPN with ability to obtain a coding certification within 12 months of hire.
• 5+ years of coding experience in assignment of ICD‑10 diagnostic coding.
• 2+ years of experience with Medicare Advantage – Risk Adjustment CMS Documentation & Coding Guidelines.
• Advanced proficiency and meticulous attention to detail, with thorough understanding of government rules and potential risk for fraud and abuse.

• Associate degree in related field…